Becoming an NP with little to no nursing experience??

PMFB-RN, RN · Nov 4, 2007

If you look at Dr. Fords work, NP training from the beginning built on nursing roots to advance nursing practice. This has evolved over the years. I have not found any specific data, but DE programs are a relatively recent addition from what I read, probably paralleling the DE BSN programs for non nurses in the early 90's.

*** PA programs allow qualified people to enter directly without ever having touched a patient. I know this works and that the turn out fine PAs. So what is wrong with allowing NP students to enter directly without eve having worked as a nurse? If the program takes this into account (as a PA program must) then whats wrong with direct entry?

So there is no double standard. One program is designed to train PAs according to the standards laid down by the PA profession. There is some data that PAs with no medical experience do not preform differently on the certification exam than those that who have medical experience. There is still debate within the community but it is not backed up with data.

*** Is there data that indicates that NPs without nursing experience preform differently on their certification exam?

Final notes. As long as we are comparing apples to oranges, most PA schools that require medical experience will not accept experience as a student. They rightly acknowledge that a student is not processing the position but being a student. So an RN applying to PA school with a medical requirement would need experience as an RN.

*** I know they don't. My point is that the direct entry NP has some patient care experience totally lacking in at least some PA students at some schools.

Those PA schools that do not require patient care experience seem to be turning out high quality PAs. Why can't the same be true for NPs?

Also to the poster above, MDs do not enter practice without medical experience.

*** True but they can enter medical school without any.

core0 · Nov 4, 2007

if you look at dr. fords work, np training from the beginning built on nursing roots to advance nursing practice. this has evolved over the years. i have not found any specific data, but de programs are a relatively recent addition from what i read, probably paralleling the de bsn programs for non nurses in the early 90's.
*** pa programs allow qualified people to enter directly without ever having touched a patient. i know this works and that the turn out fine pas. so what is wrong with allowing np students to enter directly without eve having worked as a nurse? if the program takes this into account (as a pa program must) then whats wrong with direct entry?
well for one thing nps are nps and pas are pas. if you want to be a pa you have to go to pa school. the other is that pa education is substantially different than np education in both didactic composition and clinical composition which has been discussed ad-nauseum here. the three remaining medex type programs, which in my opinion are the closest to fnp training all require large amounts of medical experience prior to pa school.
so there is no double standard. one program is designed to train pas according to the standards laid down by the pa profession. there is some data that pas with no medical experience do not preform differently on the certification exam than those that who have medical experience. there is still debate within the community but it is not backed up with data.
*** is there data that indicates that nps without nursing experience preform differently on their certification exam?
unfortunately no. there is a paucity of outcomes data on np students. the only study that i am aware of supposedly showed that nps without prior nursing experience had less confidence in their clinical skills. unfortunately to my knowledge, despite being referenced at least once, it has never been published.
final notes. as long as we are comparing apples to oranges, most pa schools that require medical experience will not accept experience as a student. they rightly acknowledge that a student is not processing the position but being a student. so an rn applying to pa school with a medical requirement would need experience as an rn.
*** i know they don't. my point is that the direct entry np has some patient care experience totally lacking in at least some pa students at some schools.
those pa schools that do not require patient care experience seem to be turning out high quality pas. why can't the same be true for nps?
it is mostly a difference in educational models. i know that i am repeating this from prior posts but pa school does not build on anything. every pa student receives the same training despite their previous experience. this is to ensure a consistent product. the pharmd in my class still had to sit through pharmacology (which was taught by another pharmd). basically the model is that you get the knowledge then apply the knowledge in clinical rotations. there are some pa programs that purport to believe that pa students with medical experience make worse students since they have to be retaught things. interestingly there is outcomes data that backs this up to some extent.
also to the poster above, mds do not enter practice without medical experience.
*** true but they can enter medical school without any.

true but they can't practice without experience.

to go back to the title of the thread, you have danced around the central question when looking at nursing experience and nps. first of all there is the medical model. this is used by both pas and physicians. the didactic work is front loaded and is reinforced by the clinical training. there is no need for medical experience because you will be taught what you need to know. there are members of the pa community claim that because of the clinically focused nature of the pa education previous medical education is necessary. however, if you have read any of the arguments on this on the pa forum, you would understand that in my opinion evidence does not bear this out.

the np model was originally conceived as a natural extension for experienced nurses to progress in their nursing care into the realm of diagnosis and treatment. over the years the entry points have changed and the programs have evolved. the de programs pose a particular question. np programs have traditionally front loaded clinical experience. in the original program it was a continuation of the nursing experience. the term advanced practice nurse comes from this concept. if this clinical experience is relevant then what are the de programs replacing with. the programs i have looked at have not substantially lengthened either the clinical or the didactic portion of the bsn or the np programs.

now i have argued that not all experience is similar or even relevant, but you bring up a deeper issue here which i believe has also been stated before. if nursing experience in not needed for nurse practitioners then logically why is nursing needed for nurse practitioners. you can argue that it is the study of nursing is what is required via the bsn, but surely there are more efficient ways to do that then the de courses. i think this is the essence of the vitriol that you see even on this board. i would point out that there is a relevant model in the nurse midwife. you can be an rn and be a cnm or for the non rns there is the cm. both of these certifications are done by the same organization. the lack of outcomes studies only compounds the argument.

david carpenter, pa-c

patrick1rn, MSN, RN, NP · Dec 15, 2007

True but they can't practice without experience.
To go back to the title of the thread, you have danced around the central question when looking at nursing experience and NPs. First of all there is the medical model. This is used by both PAs and physicians. The didactic work is front loaded and is reinforced by the clinical training. There is no need for medical experience because you will be taught what you need to know. There are members of the PA community claim that because of the clinically focused nature of the PA education previous medical education is necessary. However, if you have read any of the arguments on this on the PA forum, you would understand that in my opinion evidence does not bear this out.
The NP model was originally conceived as a natural extension for experienced nurses to progress in their nursing care into the realm of diagnosis and treatment. Over the years the entry points have changed and the programs have evolved. The DE programs pose a particular question. NP programs have traditionally front loaded clinical experience. In the original program it was a continuation of the nursing experience. The term advanced practice nurse comes from this concept. If this clinical experience is relevant then what are the DE programs replacing with. The programs I have looked at have not substantially lengthened either the clinical or the didactic portion of the BSN or the NP programs.
Now I have argued that not all experience is similar or even relevant, but you bring up a deeper issue here which I believe has also been stated before. If nursing experience in not needed for nurse practitioners then logically why is nursing needed for nurse practitioners. You can argue that it is the study of nursing is what is required via the BSN, but surely there are more efficient ways to do that then the DE courses. I think this is the essence of the vitriol that you see even on this board. I would point out that there is a relevant model in the nurse midwife. You can be an RN and be a CNM or for the non RNs there is the CM. Both of these certifications are done by the same organization. The lack of outcomes studies only compounds the argument.
David Carpenter, PA-C

Again David, you find a way to say something about the nursing profession and the role of nurse practitioners. The didactic load in NP school is reviewed and studied and reinforced through the clinical experience. I dont know what this nursing model is that you talk about in NP school, I have never met this model. Maybe because it is taught by experienced Nurse practitioners that this supposed nursing model is what is meant. Today in clinicals, I was examining patients, getting histories, ordering labs, x rays and prescribing medicine and treatment for my patients under the watch of my eye of my preceptor NP and my other clinical site with my preceptor MD. I write a SOAP note just like any other provider, their isnt some magical nursing model that i go through to evaluate a patient. I dont utilize references by NPs alone, I utilize references made by pharmacists, MDs, NPs, DOs and even some PAs. But the point is, when you go to a NP school, one needs to know about the basics already to include understanding the clinical significance of what altered labs looks like in a patient such as a cbc, cmp, PT INR. PTT, Thyroid Levels, Lipids, Renal profiles, Pancreatic levels, Urines, Stools, Pregnancy tests, cardiac markers,PFTs well those are the basics, but having just spurted all that out, my point is NP school is taught pretty quick, it is an intense program and required RNs to have a great grasp of at least those basic labs in treating patients for various medical conditions associated .. etc. Having said that, if a NP student is not sure of something, then is the time to learn it. We have certain clinical skills that have to be performed several times during out clinicals, albeit not an exhaustive list, a decent amount of skills. So yea anyway, I feel that the NP program required a smart RN who knows those basics to make for a good NP.

core0 · Dec 15, 2007

Again David, you find a way to say something about the nursing profession and the role of nurse practitioners. The didactic load in NP school is reviewed and studied and reinforced through the clinical experience. I dont know what this nursing model is that you talk about in NP school, I have never met this model. Maybe because it is taught by experienced Nurse practitioners that this supposed nursing model is what is meant. Today in clinicals, I was examining patients, getting histories, ordering labs, x rays and prescribing medicine and treatment for my patients under the watch of my eye of my preceptor NP and my other clinical site with my preceptor MD. I write a SOAP note just like any other provider, their isnt some magical nursing model that i go through to evaluate a patient. I dont utilize references by NPs alone, I utilize references made by pharmacists, MDs, NPs, DOs and even some PAs. But the point is, when you go to a NP school, one needs to know about the basics already to include understanding the clinical significance of what altered labs looks like in a patient such as a cbc, cmp, PT INR. PTT, Thyroid Levels, Lipids, Renal profiles, Pancreatic levels, Urines, Stools, Pregnancy tests, cardiac markers,PFTs well those are the basics, but having just spurted all that out, my point is NP school is taught pretty quick, it is an intense program and required RNs to have a great grasp of at least those basic labs in treating patients for various medical conditions associated .. etc. Having said that, if a NP student is not sure of something, then is the time to learn it. We have certain clinical skills that have to be performed several times during out clinicals, albeit not an exhaustive list, a decent amount of skills. So yea anyway, I feel that the NP program required a smart RN who knows those basics to make for a good NP.

I'm not sure where you got nursing model in the post above. The quote was :"The NP model was originally conceived as a natural extension for experienced nurses to progress in their nursing care into the realm of diagnosis and treatment."

The NP model at least as I describe it is different from the medical model in two respects. It integrates clinical time with didactic time (as opposed to most medical training models that sequentially teach the didactic then clinical portions). It also integrates nursing research into the curriculum.

Also your last statement (bolded) brings up the point that I was trying to make: "If this clinical experience is relevant then what are the DE programs replacing with."

I really don't know what it takes to make a good NP (or more specifically a good NP student). Hence this discussion.

David Carpenter, PA-C

CraigB-RN, MSN, RN · Dec 15, 2007

Again David, you find a way to say something about the nursing profession and the role of nurse practitioners. The didactic load in NP school is reviewed and studied and reinforced through the clinical experience. I dont know what this nursing model is that you talk about in NP school, I have never met this model. Maybe because it is taught by experienced Nurse practitioners that this supposed nursing model is what is meant. Today in clinicals, I was examining patients, getting histories, ordering labs, x rays and prescribing medicine and treatment for my patients under the watch of my eye of my preceptor NP and my other clinical site with my preceptor MD. I write a SOAP note just like any other provider, their isnt some magical nursing model that i go through to evaluate a patient. I dont utilize references by NPs alone, I utilize references made by pharmacists, MDs, NPs, DOs and even some PAs. But the point is, when you go to a NP school, one needs to know about the basics already to include understanding the clinical significance of what altered labs looks like in a patient such as a cbc, cmp, PT INR. PTT, Thyroid Levels, Lipids, Renal profiles, Pancreatic levels, Urines, Stools, Pregnancy tests, cardiac markers,PFTs well those are the basics, but having just spurted all that out, my point is NP school is taught pretty quick, it is an intense program and required RNs to have a great grasp of at least those basic labs in treating patients for various medical conditions associated .. etc. Having said that, if a NP student is not sure of something, then is the time to learn it. We have certain clinical skills that have to be performed several times during out clinicals, albeit not an exhaustive list, a decent amount of skills. So yea anyway, I feel that the NP program required a smart RN who knows those basics to make for a good NP.

I agree with you that I've never met this nursing model either and have no idea what she looks like. :)

I aactually got told that I might not have it to be an NP because, I didn't get it. 2 years later, I still have no idea, becasue I'm learning the same things as my PA wife. No differnce at all.

jjjoy, LPN · Dec 27, 2007

Now I have argued that not all experience is similar or even relevant, but you bring up a deeper issue here which I believe has also been stated before. If nursing experience in not needed for nurse practitioners then logically why is nursing needed for nurse practitioners.

This seems odd to me as well. Nursing school and it's pre-reqs covers some anatomy and physiology. Nursing courses in med-surg, geriatrics, etc give snapshots of s/s, pathophys, txts and prognosis. But much of nursing school is about nursing... the specific roles and tasks of the nurse in different clinical settings. And the nursing role is different than diagnosing and prescribing. So someone fresh out of nursing school still isn't going to have much depth of understanding of pathophys, txts etc (though there are probably a few shinging stars who have the exceptional previous life experience and advanced coursework, the average new grad nurse does not).

As has been noted, if experience as a nursing in a specialty area isn't required for entry to a NP program such that the incoming NP student already knows the critical labs, s/s, pathophys, meds off hand, then that would seem to mean that the NP program is comprehensive in and of itself. Which leads to the question of why nursing is needed for DE nurse practitioners. In other words, how much does the RN portion of the training contribute to the preparation of the direct-entry NP?

amzyRN · Dec 28, 2007

This seems odd to me as well. Nursing school and it's pre-reqs covers some anatomy and physiology. Nursing courses in med-surg, geriatrics, etc give snapshots of s/s, pathophys, txts and prognosis. But much of nursing school is about nursing... the specific roles and tasks of the nurse in different clinical settings. And the nursing role is different than diagnosing and prescribing. So someone fresh out of nursing school still isn't going to have much depth of understanding of pathophys, txts etc (though there are probably a few shinging stars who have the exceptional previous life experience and advanced coursework, the average new grad nurse does not).
As has been noted, if experience as a nursing in a specialty area isn't required for entry to a NP program such that the incoming NP student already knows the critical labs, s/s, pathophys, meds off hand, then that would seem to mean that the NP program is comprehensive in and of itself. Which leads to the question of why nursing is needed for DE nurse practitioners. In other words, how much does the RN portion of the training contribute to the preparation of the direct-entry NP?

From what I learned of basic nursing so far (I'm doing a second degree accelerated BSN), the RN's (basic assessment) is to tell the difference between normal and abnormal. (the medical component) It's an introduction to a general diagnostic physical exam that a more advanced practitioner would perform with more skill and knowledge of medical science, etc. It's still an intro and makes further study easier, just being introduced to the terminology and such. The other part, the "nursing process" is conceptual framework to do a broad range of things for patients are not purely curative. In short, I do find that this is somewhat relevant to what is learned at a more advanced level. It's an introduction and a process of familiarizing and getting acquainted with the western health care system. It may help someone find out what they want to do w/in that system and what they may want to specialize in and if they want a further study in nursing or the medical model to treat illness. I'm hoping that RN experience is relevant to more advanced study b/c that's the route I've chosen, so maybe I'm a little biased.

It seems to me that critical care experience in particular may be usefull for later practice. But I'll have a more informed opinion later on. Thanks for your post,

J

patrick1rn, MSN, RN, NP · Dec 28, 2007

From what I learned of basic nursing so far (I'm doing a second degree accelerated BSN), the RN's (basic assessment) is to tell the difference between normal and abnormal. (the medical component) It's an introduction to a general diagnostic physical exam that a more advanced practitioner would perform with more skill and knowledge of medical science, etc. It's still an intro and makes further study easier, just being introduced to the terminology and such. The other part, the "nursing process" is conceptual framework to do a broad range of things for patients are not purely curative. In short, I do find that this is somewhat relevant to what is learned at a more advanced level. It's an introduction and a process of familiarizing and getting acquainted with the western health care system. It may help someone find out what they want to do w/in that system and what they may want to specialize in and if they want a further study in nursing or the medical model to treat illness. I'm hoping that RN experience is relevant to more advanced study b/c that's the route I've chosen, so maybe I'm a little biased.
It seems to me that critical care experience in particular may be usefull for later practice. But I'll have a more informed opinion later on. Thanks for your post,
J

Good, if you want to be a nurse practitioner, you need experience as a RN, people are crazy if they think otherwise. I dont know what they are thinking.

PMFB-RN, RN · Dec 31, 2007

Good, if you want to be a nurse practitioner, you need experience as a RN, people are crazy if they think otherwise. I dont know what they are thinking.

*** Why not then for PAs who do much the same job, and often exactly the same job?

amzyRN · Dec 31, 2007

*** Why not then for PAs who do much the same job, and often exactly the same job?

Maybe b/c NPs technically practice nursing which is supposedly broader than medicine, where PAs practice medicine per se, so they would require less training. Also, PAs do more clinical hours and many have medical experience. In fact RNs sometimes go into PA school rather than going on to get a masters in nursing. Also, PA training is more "science based" like med school, so that's supposed to trump everything else possibly. BTW, I'm not arguing that RN exp is required, but just listing possible reasons why people may think NPs need exp as RNs. My opinion is that prior med experience can only help future practice. I am finding that in my program (2nd degree accelerated BSN) the assessment part of the training sets the stage for more advanced skills, since that is part of medical diagnosis for the advanced practitioner. I don't know yet if actual exp is required for me, I guess I'll have to wait and see. I would guess that the experienced RN has a broader knowledge base of pharmacology and pathophysiology, etc. just from being exposed to more of that at work, than someone who was completely new to the medical field. I don't think that RN experience is necessary though to be a good NP, just that it is probably helpful.

J

jjjoy, LPN · Jan 1, 2008

*** Why not then for PAs who do much the same job, and often exactly the same job?

If you're asking this, I have to wonder if you've taken the time to read this entire thread as this is the main topic of the thread.

The reasoning as I understand it is that in the past most NP program were geared to educate nurses who already had plenty of experience in their chosen field of advanced nursing practice. That is, they had already had ample opportunity to hone their assessment skills and that for their specialty area they already knew the expected treatments, complications, etc. And then NP school only would need to quickly cover such topics, just filling in any gaps in an individuals' knowledge. The main focus, then, of NP training would be learning the new role of diagnostician and treatment-prescriber. I don't know if that's actually how such programs have worked.

When I looked in to PA programs some years back, some kind of health related experience was recommended but wasn't required. The material I reviewed made it sound as if PA programs were complete unto themselves in preparing the students for clinical practice... unlike NP programs which mostly have required previous RN training at the least, and usually at least some experience as a practicing RN.

Of couse, it seems that many NP programs these days also don't require previous clinical experience outside of school for acceptance to a program - direct entry programs certainly don't. Hopefully, direct entry programs adequately address the different issues between training clinically experienced RNs for an NP role and training up NPs who don't have a lot of clinical experience. If the programs do this well, then, I'd agree that there's no need for nursing experience.

My own experience with nursing school at the RN level was that we were underprepared for the "real world" and had no real clinical judgement skills upon graduation. We'd be introduced to nursing skills and knew the "how" and the "what" but had very little opportunity to see and do and apply skills in the clinical arena as students. Mostly, we wrote care detailed care plans and scrambled for the few opportunities to check off our skills list for graduation. I certainly hope NP programs instill more experience in students before turning them loose with their own licenses.

shah · Jan 21, 2008

Go for it, and don't listen to the nay sayers!

As a paramedic, you have just the right kind of experience for the NP role. That of taking independent decisions. Nurses on the other hand, still take orders on the floor and 'fetch' most of the time, in spite of their more in depth preparation.

Your ACLS training and experience is better than of nurses.

The direct programs will first make you a nurse. You will sit for the NCLEX.

Then they will not let you take any clinical courses till you have completed about a 1000 hours of clinical experience as an RN.

For God's sake do not go for Excelsior as they are not recognized in CA or IL.